Three-dimensional gait analysis for assessing dynamic ankle spasticity after stroke.

The study used a single-center case-control design, which limits causal inference and generalizability. Propensity score matching was used, but residual selection bias may still exist. The sample size was relatively small (84 participants), which may affect the stability of the regression models. The Modified Tardieu Scale X score showed a ceiling effect, potentially limiting the detection of severe spasticity. Cognitive function and other neurological factors that influence gait were not assessed. Participants had to be able to walk independently without assistive devices, so findings do not apply to more severely impaired patients.

The study was funded by the Natural Science Foundation of Shanghai, the Fundamental Research Funds for the Central Universities, the National clinical key specialty construction project of China, the Shanghai Rehabilitation Medical Research Center, and the Shanghai Hospital Development Center Foundation.

Do not assume that bedside findings of reduced plantarflexion range and weak dorsiflexors prove dynamic spasticity is the sole cause of gait impairment. These factors are associated with the presence of spasticity, but the study does not establish causality, and other neurological or musculoskeletal issues may contribute to the observed gait patterns.